Tribhuvan University Teaching Hospital (TUTH) is a tertiary care hospital in Kathmandu. The emergency department sees between 130 to 140 cases per day. These patients get initial evaluation and basic investigation for acute emergency management and treatment. Those requiring further treatment are then admitted to the department of General Practice for post emergency care which acts as an observation ward. This step allows for the patients to be observed on a short-term basis and permits patient monitoring and/or treatment for an initial 24-48 hour period and up to a maximum of five days. These steps allow for focused follow up, improved efficiency and minimizes inappropriate admissions to other hospital inpatient wards. This paper evaluates functionality, admission criteria, patient categorization and subspeciality referral to specialty patient care, discharge criteria and cost effectiveness.

A descriptive observational study was carried out of the patients admitted to the observational ward between 2020-2021.

Most articles suggest these wards improve patient satisfaction and clinical care, decrease length of stay, reduce unnecessary inpatient hospital admissions and are useful in fever under evaluations, COPD, poisoning, pneumonia, mild head injuries, high sugar, hypertension, gastroenteritis etc. Around 14% of patients were sent to the observation ward after acute emergency care. 84% were discharged from observation ward with a mean stay of three days and were followed up in community care or GP OPD. Nine percent were admitted to hospital wards, and 7% transferred to yellow/red area emergencies for derange vitals.

Observation wards seem to have advantages, excluding those who will inevitably need longer treatment, reduces cost savings and unnecessary burden of hospital admission.

Head trauma is a high-risk presentation to the emergency department (ED). Preventing secondary brain injury through earlier diagnosis and intervention relies on timely access to head CT. Wexford General Hospital (WGH) ED uses NICE guidelines, which recommend specific timeframes for acquiring CT in head trauma. Following an audit demonstrating low compliance to NICE CG176 time standards in 2020 (34%), a quality improvement project was undertaken to optimize imaging pathways for head trauma.

94 head trauma CT scans were analyzed over a two-month period (June 14, 2022-August 14, 2022) from the NIMIS and IPMS databases to establish current time compliance and median wait times for CT.

Following the implementation of a head injury assessment proforma at triage to prompt earlier evaluation of high-risk head injuries, 108 head trauma CT’s were reviewed over a two-month period (August 15, 2022-October 15, 2022) to determine if these parameters improved.

Unpaired, two-tailed Mann-Whitney’s test was used to compare median wait times from triage to CT. Two-tailed Chi-square test was used to compare overall compliance rates.

Overall ED compliance to NICE time standards improved following implementation of the proforma (43% vs. 36%, p=0.401).

For CT scans that were indicated within one hour, there was a statistically significant decrease in median wait time from triage to CT (134mins vs. 186mins, p=0.046). There was also a decrease in median wait time for scans indicated within 8 hours; however, this did not reach the threshold for statistical significance (216mins vs. 275mins, p=0.230).

Although there was an overall reduction in wait times for CT, this did not translate to a significant improvement in compliance rates to NICE CG176 time standards. This suggests that, despite earlier identification of these high-risk head injuries at triage, other systemic barriers to obtaining head CT are present and warrant further investigation.

The use of ECMO devices began about 50 years ago. The purpose of the ECMO device is to enable gas exchange (oxygen and carbon dioxide) and/or hemodynamic support in situations of pulmonary or heart failure to recover or to serve as a bridge in a waiting period for heart pulmonary, heart, or artificial heart transplantation. The COVID-19 outbreak increased the need for the use of ECMO as a life-saving treatment. As a result, there was an increasing demand for qualified personnel in overloaded hospitals' ICUs to care for COVID-19 patients in general, specifically for those who required ECMO treatment. These required rapid team training and new methodology development collaboration between the Ministry of Health (MOH), multi-disciplinary teams, and a national professional committee that set the treatment protocols based on universal standards.

A professional national committee was appointed by the MoH. The committee included Physicians, Nurses, Cardiopulmonary Bypass Machine Operators/Perfusionists as well as MoH representatives. The role of the committee was to establish guidelines and standards for operating ECMO services. These guidelines were adopted by the MoH and are the basic recommendations for operating ECMO units in Israeli hospitals.

The whole process had a dual challenge. One challenge was establishing new ECMO units according to the guidelines and the universal standards created by the committee. The other challenge was to motivate the old and experienced ECMO units to adopt and work according to the official standards set by the committee.

These days the committee started the evaluation of the old ECMO Units to bring all ECMO units in Israel to work by the same guidelines and standards.

The SARS-CoV-2 virus 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the Flexible Surge Capacity concept in relieving hospitals by focusing on the community resources to develop “Home Isolation Centers” in Bangkok, Thailand.

This is a qualitative study consisting of observational and semi-structured interview data. The development and activities of Home Isolation Centers were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analyzed and categorized based on the practical elements necessary in disaster and emergency management.

The obtained data could be categorized into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: 1) coordination and collaboration, 2) staff engagement, 3) responsibility clarification, and 4) sustainability. Safety presented two subcategories: 1) patients’ information privacy and treatment, and 2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment, and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organization guidelines and hospital operations. Several supplies and patient-related challenges were identified and managed during center development.

The use of community resources, based on the flexible surge capacity concept, was feasible under restricted circumstances and enabled the relief of hospitals during the pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of the emergencies’ etiology.

The Emergency Department (ED) is the hospital’s main gateway, as well as the initial site for diagnosis and emergency medical care. In recent years, ED overcrowding is worsening in Israel and world-wide. Overcrowding has been shown to adversely affect patient service and care, fostering patient and caregiver dissatisfaction, as well as lowering quality of care and even increasing mortality. A main driver of ED overcrowding is ED patient boarding due to limited inpatient bed availability in conjunction with hospital policy. Measuring median length of ED stay (LOS) for admitted vs. discharged patients can serve as a simple indicator for the severity of the access block over time and between facilities.

ED operational data from the computerized system of four hospitals in Israel were collected over a year and analyzed. In parallel data was collected regarding hospital capacity and ED volumes. Data were analyzed using SPSS.

The Mean ED LOS was significantly higher for ED patients needing admission in all hospitals. Mean ED LOS for admitted vs. discharged patients was 227 min vs.431 in hospital A, 215 min vs. 222 in hospital B, 198 min vs. 440 in hospital C and 167 min vs. 190 in hospital D. The discrepancy in LOS for admitted patients was not related to the total hospital bed capacity or the hospital ED patient volume.

ED boarding is a major challenge for ED's and hospitals worldwide and a significant contributor to ED overcrowding. A tool to assess boarding is proposed. The tool calculates the ratio of median ED LOS between patients admitted to the hospital and those discharged. Slightly higher LOS among those admitted is to be expected, considering the fact that they usually present with more complex medical problems. In this study the LOS ratios were 1.03, 1.12, 1.90 and 2.22.

Early recognition and treatment of critical clinical conditions have decreased morbidity and mortality in critically wounded and sick patients. Worldwide, Emergency Rooms (ER) are overcrowded, and the complexity and number of patients keep increasing. This phenomenon challenges health professionals when applying time-sensitive interventions generating unfavorable outcomes. Considering that the ER is the first point of contact for patients of Hospital Escuela, a 1306-bed, academic, tertiary care hospital in Honduras, we describe the creation of a Resuscitation Room (RR) to improve patient care in the ER.

Data from patients, including dates, source of admission, diagnosis, and outcomes, were recorded daily in a database from June 1, 2022, until October 31, 2022. Then the analysis and interpretation were made using Microsoft Excel.

In the five-month period, 1,118 patients were admitted to the RR, with 58% males, a 52-year-old mean, and October as the busiest month (33%). Most patients consulted between 0600 and 1800 hours (70%). The primary admission cause was a medical condition (71%), and shock (41%) was the most common type of emergency followed by trauma (25%). After stabilization, 86% of patients remained in observation areas of the ER, only 5% went to the operating theater, and 1% to the intensive care unit. The mortality rate was 5%, 48% trauma related.

A RR meeting the minimal standards for space, trained staff, medical equipment, and consumable resources has been shown to be beneficial in improving interdisciplinary work in the ER. This RR has enabled life-threatening conditions to be recognized and treated rapidly while also promoting information gathering on critically wounded and sick patients and their outcomes. The need to standardize the clinical care to such patients has also been identified. Further efforts to protocolize the response are needed to improve patient care.

There is a clear need for research evidence to drive policymaking and emergency responses so lives are saved and resources are not wasted. The need for evidence support for health and humanitarian crisis is pertinent because of the time and practical constraints that decision makers in these settings face. To improve the use of research evidence in policy and practice, it is important to provide evidence resources tailored to the target audience. This study aims to gain real-world insights from decision makers about how they use evidence summaries to inform real-time decision making in crisis settings, and to use the findings to improve the format of evidence summaries.

This study used an explanatory sequential mixed method study design. First, a survey was used to identify the views and experiences of those who were directly involved in crisis response in different contexts, and who may or may not have used evidence summaries. Second, the insights generated from the survey helped inform qualitative interviews with decision makers in crisis-settings to derive an in-depth understanding of how they use evidence summaries and their desired format for evidence summaries.

Twenty-six decision-makers working in health and humanitarian emergencies were interviewed. The study identified challenges decision makers face when trying to find and use research evidence in crises, including insufficient time and increased burden of responsibilities during crises. Decision makers preferred the following components in evidence summaries: title, target audience, presentation of key findings in an actionable checklist, implementation considerations, and assessment of the quality of evidence presented. The study developed an evidence summary template with accompanying training material to inform real-time decision making in crisis settings.

The study provided a deeper understanding of the preferences of decision-makers working in health and humanitarian emergencies regarding the format of evidence summaries to enable real-time evidence-informed decision-making.

According to the Internal Displacement Monitoring Centre (IDMC), more than 60% of the internal displacements recorded worldwide in 2021 were due to disasters. A conservative estimate by IDMC reports 65,000 new displacements between July 2019 and February 2020 as a result of the Black Summer bushfires and more than 42,000 displacements due to flooding in February and March 2022 in Australia. These are estimates as there are no consistent or consolidated data on those who are displaced in Australia affecting the measurement of the magnitude of displacement, and the knowledge of experience, impact and needs of displaced people to inform policy and practice. Thus, the aim of this study, as part of a larger project, is to review key international and Australian policies about data on internal displacement due to disasters.

We conducted a desk review of key international policies, such as the Sendai Framework for Disaster Risk Reduction and from the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), as well as Australian policies such as the Australian Disaster Preparedness Framework, Emergency Management Arrangements Handbook and even state level emergency legislation/acts and plans to understand the data collection and supports and services provided to those who become displaced due to disasters.

This review found that both international and Australian policies lacked specific focus on internal displacement, despite it being a key issue. While international policies and procedures in low income countries exist, in particular where the international humanitarian system is operational, this review found that Australia lacked specific focus on internal displacement.

Data on displacement due to disasters, including the number of people displaced, and the patterns of their displacement is critical to inform better policies on prevention, emergency planning, evacuation response and finally to improve the support that people who are experiencing displacement receive.

The concept of disaster related internal displacement is typically seen as something that occurs in low-income countries and is rarely considered in the setting of high-income countries. This leads to a paucity of data to support contextually appropriate best practices to address displacement. This research, funded by the Australian government, explores the lived experiences of those faced with forced displacement from disasters in high-income countries and aims to improve outcomes for this vulnerable cohort.

The first phase of the research, guided by a broad-based Steering Group, included a rapid literature review and thematic analysis of peer-reviewed literature of disaster related, internal displacement in high-income countries, including Australia.

The peer reviewed literature review identified only 12 papers that met the inclusion criteria. The literature from Australia and other developed countries indicated that internal displacement is a prominent feature of disaster impacts and that needs are complex, dynamic and diverse. Common themes of need were revealed: the need for the development of an evolving displacement policy framework to support human rights; the co-creation, coordination and provision of timely and flexible support services, and on-going data collection and sharing. No displacement, specific frameworks, measurable thresholds, or central data registries exist at federal or state government levels in Australia to support these needs.

Inclusive policies, practices, and resources are required in Australia to support assets of displaced people and address their unmet needs in disasters, which also remain largely unmet in other high-income countries. Australia can learn from all countries faced with the challenges of managing displacement and also share its own experiences. Furthermore, it is recommended that WADEM consider extending its current Position Statement relating to Refugees and Internally Displaced Persons to include high-income countries based on the findings of our study and other sources.

Overcrowding in the Emergency Room (ER) is a worldwide phenomenon affecting healthcare professionals' ability to apply life-saving interventions to critically wounded and sick patients. Implementing a routine triage system allows the early recognition and treatment of critical conditions such as polytrauma, difficulty in breathing, shock, and altered mental status. Furthermore, a triage system allows the prioritization of patients and the delivery of timely care. We describe the improvements in patient care for the critically ill through the implementation of a triage system in Hospital Escuela (HE), a 1306-bed, academic, tertiary care hospital in Honduras

Demographic data was recovered through paper triage forms from January 2020 until December 2021. From January 2022 to June 2022, the data was primarily recovered from digital triage forms. The data was consolidated, analyzed, and interpreted using Microsoft Excel.

During the thirty-month period, there were 161,848 triage consults, with 2.7% being critically wounded and sick patients, classified “red” according to the triage system. Most cases were triaged as yellow (53%), followed by green (23.6%), and then orange (15.8%). Some triage forms (5%) did not assign classifications. One-third (33.4%) of consults were diverted from the ER to the Triage and Urgent Care Room (SATU for the acronym in Spanish). Trauma-related cases accounted for 26.2% of the consults with 3.6% of the overall being weapon wounded.

Implementing a triage system in HE enhanced the recognition and treatment of critically wounded and sick patients. This system has improved patient flow and the use of clinical space in the ER by diverting low-acuity patients to the SATU. Multi-disciplinary collaboration among healthcare professionals has also improved and the need to create a centralized Resuscitation Room was recognized.

The current war in Ukraine and the subsequent deployment of Non-Governmental Organizations (NGOs) from around the world has highlighted the many potential dangers faced by humanitarian aid workers operating in conflict zones. Humanitarian aid workers may face both direct and indirect threats and aggression whilst on deployment, and given the rising number of global conflicts, the authors postulate a need to incorporate threat awareness training as part of pre-deployment training.

A list of the top 22 rated NGOs providing international aid was obtained from CharityWatch. All 22 were contacted via their public email addresses or website contact pages to find out if they provide any form of security, tactical, or threat awareness training.

Seven of the 13 NGOs that responded did not deploy staff into recent conflict zones or surroundings. All six NGOs who deployed staff into Ukraine or surrounding border countries, provided either security, tactical, or threat awareness training to their staff.

With the rising number of conflicts and disasters around the world, humanitarian aid workers are increasingly exposed to hostile environments and there is a compelling need for NGOs to ensure staff are adequately trained and prepared to handle any dangers and threats they may face.

Humanitarian aid is an important part of an emergency response to Disasters and crises situations. When a community or a country is hit by disasters, urgent responses are needed to save lives and provide for the basic needs of the people affected. Humanitarian actors like the Nigerian Red Cross Society, play a vital role in these urgent actions and the aid they provide is fundamental to crisis responses. Responses to humanitarian emergencies involve the mobilization of resources.

The Nigerian Red Cross Society, Lagos State Branch carried out some humanitarian actions for Lagos State populace during the peak of the Covid 19 pandemic in the year 2020 and also in 2021 with the support of well meaning Nigerians, IHS, and the British Red Cross who donated, supported and sponsored the activities.

The offshoot of the COVID-19 operation which subjected us to an extremely helpless corner, was the high magnitude of the most vulnerable people crying out for food in different suburbs and slums of Lagos following the State’s lockdown.

Humanitarian assistance was delivered based on assessed needs, and according to the humanitarian principles of humanity, neutrality, impartiality and independence, which is the fundamental principles of the Red Cross movement. The methodology of the Humanitarian Aid used includes the following:

1. Rapid Assessment

a. Criteria to be used

b. Questionnaire Guide

c. Checklist

d. Rapid Assessment Form

2. Compilation of Information obtained from the Rapid Assessment carried:

3. Validation of Data

4. Data Analysis

5. Delivery

The outcome was to limit the impact of Covid 19 and help people return to normal. The anticipated effect of the intervention on the members of the communities was achieved.

Nigerian Red Cross Society Lagos State Branch’s humanitarian investments have been able to save lives, reduced suffering and restored human dignity.

Over the past decade, the world has wrestled with two major pandemics: Ebola and COVID-19. While Ebola revealed that we needed a strategy, Covid-19 showed we still didn't have one. Apart from ensuring that we isolate and contain the virus, one of the major concerns in responding to a pandemic is limiting transmission to healthcare personnel.

This presentation describes a clinician's experience with employing the same infection control strategies used for Ebola in a makeshift Ebola Treatment Unit in a school in Sierra Leone and at a COVID-19 alternate care facility built in a convention center in the US.

Transmission control strategies used for healthcare workers during Ebola were also successful for COVID-19. Both facilities, despite grossly different access to financial resources, ensured all clinicians didn’t break protocol of safety, due to rigorous donning and doffing entrances and exits, internalized individual risk, separated spaces with tape, and zoned areas.

Two facilities with access to vastly different resources to treat two distinct infectious diseases used the same infection control measures for staff with success. Highlighting the priority of internalization of risk by healthcare workers alongside critical infection control measures proves to be the most valuable resource over multi-million dollar facilities erected during COVID.

The world's second largest Ebola virus disease outbreak in DRC (August 2018-June 2020) caused 3,481 cases in 29 health zones, 2,299 deaths and about 250,000 contacts traced. It occurred in densely populated vast areas, with insecurity, ongoing humanitarian crisis and community reluctancy. Four hubs, sixteen sub-coordinations were set up with hundreds of experts to support local inexperienced health workers. Five health coordinators were deployed to lead more than 600 people at national and field level coordinations. This work aimed at reviewing coordinators’ leadership styles using leadership theories. Recommendations were made for future complex health operations.

The leadership styles of the five coordinators were reviewed retrospectively using different leadership theories. Three groups of theories: (1) Leader’s traits, characteristics, and skills; (2) Leader’s behaviors: behavioral, transformational, and situational; (3) Authentic and servant leadership.

Analysis with the three groups of leadership theory highlighted that leaders had mixed leadership approaches.

1) Self-confident, calm, determined, extravert (one a bit shy), conscientious, motivators; Sociable and empathic while dealing with staffs affected by incidents; Few strong characters affecting interpersonal relations; Strong negotiation skills while dealing with local stakeholders; Experienced and knowledgeable in analyzing, making judgment and decisions.

2) A participative approach when supporting nationals and partners; Using transformational leadership when coaching national counterparts and mobilizing partners, Directive when teams were to comply with rules or act quickly.

3) Compassion; building trust, confidence and capacity; empowering and coaching.

The complex disease outbreak imposed a mixed leadership style. Leaders had specific traits and technical skills. Servant leadership style was often used to trigger participation and build capacity in support of national and international experts. Directive approaches were used to trigger urgent actions. Findings could help in selecting and training leaders for public health emergencies. It may require further empirical and operational research in emergency contexts.

The first cases of COVID-19 arrived in Israel in March 2020. In Israel, the first known cases were Israeli patients diagnosed with COVID-19 aboard the Diamond Princess which were repatriated.

Shortly later, additional cases were found in increasing numbers constituting the "first wave". The high number of patients put significant strain on Israeli hospitals. The initial wave was later followed by additional surges in the number of patients further straining the system. At the peak, hospitals with a total bed capacity of 800 had 135 covid-19 patients with 21 of them requiring ventilatory support.

Daily and weekly multidisciplinary meetings were held and daily reports were composed. Following each wave, lessons learned and recommendations for improved preparedness were formulated. The following results and conclusion sections summarize some of the main insights and recommendations.

The main challenges in Beilinson hospital during the "first wave" were a shortage of personal protective equipment (PPE) and how to best utilize the existing supplies, uncertainty regarding infectiveness, best management practices and uncertainty regarding the expected magnitude and duration of the pandemic. In retrospect, the major insights were the need for a flexible and divisible ED to safely care for changing loads of suspected and verified COVID-19 patients as well as COVID-19 negative patients. Increasing the in-hospital stockpile of PPE as well as the regional and national stockpile and creating local production capacities. The importance of the daily multidisciplinary managerial meeting was to improve situational awareness and allow improved decision making. Staff briefing occurred on a daily basis and during times of high uncertainty at the beginning of every shift.

Performing structured and frequent debriefing and analysis to achieve clinical and operational insights is crucial for improved short-term performance as well as improving preparedness for future challenges.

During the COVID-19 pandemic, consideration was given to co-ventilating multiple patients on a single ventilator. Prior work had shown that this procedure was possible by ventilating four adult-size sheep for twenty-four hours, and other groups had performed this maneuver during dire circumstances. However, no investigation had examined the safety regarding cross-contamination. The purpose of our studies was to investigate if an infection could spread between individuals who were being co-ventilated.

Four sterile two-liter anesthesia bags were connected to a sterilized ventilator circuit to simulate the co-ventilated patients’ “lungs.” The circuit utilized Heat and Moisture Exchange filters and bacterial/viral filters, which were strategically inserted to prevent the transmission of infectious droplets. Serratia marcescens was inoculated into “lung” number one. The circuit was then run for 24 hours, after which each “lung” and three additional points in the circuit were cultured to see if S. marcescens had spread. These cultures were examined at 24 and 48 hours to assess for cross-contamination. This entire procedure was performed a total of four times.

S. marcescens was not identified in lungs two, three, or four or the three additional sampling sites on the expiratory limb of the tubing at 24 and 48 hours in all four trials.

Cross-contamination between co-ventilated patients did not occur within 24 hours utilizing the described ventilator circuit configuration.

Covid-19 pandemic had a massive impact on the capabilities of the healthcare system. The development of the vaccines and the setup of the vaccination program of the general population required an important coordination and organizational work, from an already worn-out system.

The implementation of mass vaccination centers is known as the most efficient way of vaccinating rapidly and efficiently a large part of the population, but requires a non-negligible amount of resources. For Covid-19 vaccination, time sustainability was an important challenge to consider due to the timespan needed between boosters; unfortunately, most of the models presented up to 2020 are short duration systems.

A mass vaccination center (MVC) organizational model was proposed and staffed with only two health care workers on a daily basis, with a more than 10,000 shots a day capacity over a seven-month duration.

The MVC was under the supervision of one medical coordinator, one nurse coordinator and one operational coordinator. Students (both in health and non-health studies) were the most important part of the human resources. Data concerning the population vaccinated, the number and the type of vaccines used were routinely recorded.

From March 28 to October 20, 2021, 501,714 vaccines were administered at the MVC. A mean rate of 2951 ±1804 doses was injected per day with a staff of 180 ±95 persons working every day. The peak was reached with 10,095 injections in one day. The average time spent by a patient in the MVC was 43.2 ± 15 minutes. The average time to be vaccinated was 26 ±13 minutes.

Provided with adequate supervision, an optimized organization and adequate training, the use of a student workforce allows for the implementation of a functional, efficient, and sustainable mass vaccination center.

Information Technology has been applied to respond to the coronavirus disease 2019 (COVID-19), which has attracted increasing attention. However, there is still no comprehensive bibliometrics study in the global publications on the application of Information Technology in COVID-19. This study aimed to investigate the current research status of Information Technology in preventing and controlling the COVID-19 pandemic.

Relevant literature published between 2020 and 2022 was downloaded from Web of Science Core Collection (WoSCC) databases. Key search terms included COVID-19, big data, artificial intelligence, internet of things, cloud computing, etc. The data elements were as follows: year, countries/territories, institutions, authors, journals, research areas and citations of publications. Statistical methods and knowledge domain maps were applied to conduct contribution and collaboration, co-occurrence and co-citation analysis using VOSviewer. COOC software was used to construct the two-mode matrix, conduct hierarchical cluster analysis of high-frequency keywords and journals, and identify keywords of bursts.

A total of 10,962 articles were retrieved. The most frequent country and institution were USA (2,423, 22.10%) and the University of California System (212, 1.934%), respectively. The research areas were included but not limited to computer science (2,198, 20.051%), engineering (1,421, 12.963%) and public environmental occupational health (1,032, 9.414%). Three research hotspots were identified: (i) Internet-based social and psychological surveys; (ii) Distance education, telecommuting and telemedicine; (iii) Artificial intelligence-assisted diagnosis of COVID-19 patients. The clustering results of a two-mode matrix showed that research had the most frequent interaction with health, social media and information technology. According to co-citation analysis, a total of four clusters of journals had been obtained (clinical medicine, medicine, computer science and engineering, and public health). The keywords of burst were computer-based learning, general public, student-centered learning, etc.

Information technology has played an important role in the response to COVID-19, which belongs to the interdisciplinary field.

Hospitals experiencing a COVID-19 outbreak are in a similar situation to those affected by natural disasters, with a breakdown in command and coordination, shortage of personnel and supplies, and increased stress among staff. In Japan, when a COVID-19 outbreak occurs, the first step is for the hospital or health center to respond. However, if the local authorities are unable to respond, the Ministry of Health, Labour and Welfare dispatch Disaster Medicine Assistance Team (DMAT) by request of the local government to facilitate early recovery. This study will examine the effectiveness of early phase support by DMAT.

Patients and healthcare workers in 31 hospitals supported by DMAT after an outbreak occurred between April 2020 and January 2021 were included in the study. Attack rate and case fatality rate for patients and the attack rate for healthcare workers were analyzed for each of the two groups: those that started support less than ten days after the first positive case and those that started support more than ten days after the first positive case.

For hospitals that started support in less than ten days, the attack rate was 27.9%, the case fatality rate was 17.4% for patients, and the attack rate for healthcare workers was 9.7%. For hospitals that took more than ten days to start support, the attack rate was 44.8%, the case fatality rate was 23.1% for patients, and the attack rate for healthcare workers was 14.3%. The attack rate (p<0.001) and case fatality rate (p=0.011) for patients and attack rate for healthcare workers (p<0.001) were significantly lower in hospitals that started support in less than ten days.

Early intervention of DMAT support using natural disaster support techniques for hospitals experiencing an outbreak reduced the attack rate and case fatality rate for patients and healthcare workers.

The COVID-19 pandemic challenged healthcare systems globally disrupting access to high quality essential health services. The pandemic may be viewed as a disaster impacting on patients and staff alike. There is a paucity of research describing how large health services have maintained, scaled and innovated care during the pandemic. The study was conducted to provide insights to inform hospital disaster management responses, specifically to identify organizational learnings from the COVID-19 response, capture instances of innovation, understand the impact of COVID-19 on models of care and to identify organizational priorities to prepare for a potential future disaster or terror event.

Survey research was conducted using a qualitative research strategy. The study was conducted at a 550-bed university-affiliated tertiary hospital located in the southeast corner of Australia in the State of Victoria. The survey was purpose designed, included open-ended questions requiring text responses, and was completed in an online survey form. A thematic analysis of the data was completed.

A total of 258 staff completed the survey, with staff representing doctors, nurses, allied health, and support personnel. There were four overarching domains of learning identified; People and Care, Staff Support, Implementation of Care, and Organizational Factors. These domains were supported by 14 topic areas which highlighted specific areas of learning and opportunity in preparing for or responding to a potential future disaster or terror event

There was a need during the pandemic to pivot rapidly to reorganize services and workforce to operate and deliver care in a safe manner. Attention to and action in the domains of People and Care, Staff Support, Implementation of Care, and Organizational Factors can be considered by organizations when planning health service delivery in response to and during the COVID-19 pandemic, or more generally to a potential future disaster or terror event.